Provider Demographics
NPI:1235902966
Name:TAN, NOEL O
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:O
Last Name:TAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-3249
Mailing Address - Country:US
Mailing Address - Phone:718-808-7370
Mailing Address - Fax:
Practice Address - Street 1:3014 CRESCENT ST FL 3
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3249
Practice Address - Country:US
Practice Address - Phone:718-808-7370
Practice Address - Fax:718-808-7393
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant